This is good news and a useful tool to have in our arsenal, but this drug will not get us out of the pandemic. At best, paxlovid will relieve some of the pressure on hospitals. From what I read in the supporting literature, it looks like there was about a 78% reduction in hospitalizations in the treatment versus the placebo arm, and zero all-cause mortality deaths vs 12 in the placebo group during the approximately month long observation period. Interesting that 47% of the trial participants were "serologically negative", meaning either they were unvaccinated, without prior infection, or their existing immunity from either source faded completely (less likely, though).
The medication is only authorized for those considered "high risk of hospitalization", but I noticed they included anyone with a BMI above 25 in that list, so effectively most adults living in the western world will probably meet the eligibility criteria. I'm pretty sure the criteria is a BMI above 30 for the monoclonal antibody, so more people will likely qualify for this oral treatment than for the infusion.
Like tamiflu, this medication needs to be given as soon as possible after symptoms develop. With the availability of at-home tests for COVID, this should make it much easier to hit the eligible population in the proper time window.
Now, the all-important caveats. Unlike the very rare incidence of severe side effects in the vaccines, protease inhibitors tend to have some rather significant toxicities. This might not be a huge issue, because we usually see these side effects with chronic use of the medications in HIV patients, and the prescribed course of paxlovid is relatively short. We'll probably only get a better handle of this as the medication becomes more widely administrated in the general population.
The other surprising caveats were some of the drug interactions that will contraindicate paxlovid use. Some of these drugs are fairly common, such as alfuzosin, amiodarone, flecanide, carbamazepine, phenytoin, lovastatin, simvastatin, salmeterol, and even sildenafil (aka, viagra). Some of the contraindicated medications can probably be stopped temporarily, but someone taking amiodarone and flecanide for a heart arrhythmia, carbamazepine or phenytoin for seizures, or sildenafil for pulmonary hypertension can't just stop these medications without potentially severe consequences. So, some of the people who are sickest and most vulnerable at baseline may not be able to take paxlovid.